title: Transaortic modification of the Viabahn open revascularization technique (VORTEC) to facilitate renal artery revascularization in a hybrid EVAR procedure.
abstract: OBJECTIVE
  To present a modification of the Viabahn open revascularization technique (VORTEC) to facilitate right renal artery (RRA) revascularization via a limited thoracotomy and transaortic sheath during endovascular aneurysm repair (EVAR).
  
  
  METHODS
  A 51-year-old man with uncontrolled hypertension and limited respiratory reserve presented with a pararenal abdominal aortic aneurysm (AAA) measuring ∼15×8.5×8 cm extending into the iliac arteries. Via a limited low thoracoabdominal incision and retroperitoneal approach, 3 of the renovisceral branches were exposed, but there was difficulty in approaching the RRA. A handmade 4-branched polytetrafluoroethylene graft (PTFE) was anastomosed to the descending thoracic aorta, and the 3 exposed renovisceral branches were bypassed sequentially. A modification of the VORTEC with a transaortic approach to revascularize the RRA was successful; a 7-mm×10-cm Viabahn stent-graft was advanced into the RRA and deployed into the RRA limb of the PTFE graft. The Viabahn-PTFE graft junction was fixed with interrupted suture, and its transaortic portion was dilated with a 7-mm balloon. EVAR was then accomplished with a 28.5-mm Excluder stent-graft. The final angiogram documented patent bypass grafts and no endoleak. Follow-up imaging showed a satisfactory stent-graft and patent PTFE graft without undue kinking of the Viabahn or stenosis within its transaortic portion. The patient remained well after 1-year follow-up.
  
  
  CONCLUSIONS
  This transaortic modification may be a useful option for hybrid EVAR and application of a sutureless telescoping anastomosis technique.
authors.affiliation: 1 Division of Cardiovascular Surgery, Department of Surgery, Medical College and.
authors.forename: Meng-Ta
authors.initials: MT
authors.lastname: Tsai
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Tseng
authors.forename: Chung-Dann
authors.initials: CD
authors.lastname: Kan
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015607:Stents; D013536:Suture Techniques; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene